| (1) |
Holtgrave
and others estimated that it cost $34,300 in
prevention dollars for each HIV infection averted while they
estimated that the
lifetime cost of medical care for an injecting drug user was $108,500. The cost estimate assumes that sterile
syringes are provided through a combination of syringe exchange
programs (25 percent) and pharmacy syringe sales (75
percent). For this 25%/75% combination of syringe exchange
programs and pharmacy sales, 66 percent of the total problem
costs are from syringe exchange programs and 34 percent from
pharmacy syringe sales. In the analysis, most of the costs
of the pharmacy sales are paid by injecting drug users when they
purchase syringes.
The
estimate for lifetime treatment cost of persons newly infected
with HIV is $195,188. The $108,500 figure given in the preceding
paragraph is 56 percent of that figure and was used because a study
by Reitmeijer and others showed that less is spent on HIV/AIDS treatment
for IDUs than for homosexual men. Reitmeijer found
that the annual cost of HIV/AIDS treatment for white IDUs was 89
percent the cost for white homosexual men and that the annual
cost for nonwhite IDUs living with HIV/AIDS was about 49 percent
of that for nonwhite homosexual men. A
2000 report by the Institute of Medicine argued that directing
prevention efforts to populations at high risk of infection and
using interventions of proven efficacy and cost-effectiveness
could prevent an estimated 20 to 30 percent more infections than
does the current allocation of HIV prevention funds. The
U.S. is currently spending $7.5 million per HIV infection
averted through the blood supply; $32,700 per HIV infection
prevented through screening pregnant women; and $3,000 to $5,000 per HIV infection avoided through needle exchange
programs.
David
R. Holtgrave, Steven D. Pinkerton, T. Stephen Jones, Peter Lurie, and David
Vlahov, 1998, Cost and cost-effectiveness of
increasing access to sterile syringes and needles as an HIV
prevention intervention in the United States, Journal of Acquired
Immune Deficiency Syndromes and Human Retrovirology, 18
(supplement), pp. S133-S138. (Abstract.) C.A.
Reitemeijer,
A. J. Davidson, C.T. Foster, and D.L. Cohn, "Cost of care
for patients with human immunodeficiency virus infection. Archives
of Internal Medicine, 1993, vol.153, pp. 219-25. Institute
of Medicine. 2000. No Time to Lose: Getting More from HIV
Prevention. Ruiz, Monica
S., Alicia R. Gable, Edward H. Kaplan and others, eds.
Washington, D.C. National Academy Press. pages 4 and 25. Executive
summary and full report. Press
release. Opening
statement at press conference.
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In 1989, Congress declared that no federal money could be
spent to support clean-needle programs until the federal
government could provide scientific evidence that such programs
both reduced the spread of HIV and did not encourage drug use.
In April 1998, after a meticulous review of the
scientific evidence, Health and Human Services Secretary Donna
Shalala certified that the congressional mandate had been met.
While Secretary
Shalala did certify that needle exchange programs are effective,
she did not release federal HIV prevention funds for this
purpose. Further details.
Sheryl Gay
Stolberg, Clinton Decides Not to Finance Needle
Program, New York
Times, April 21, 1998, p. A1.
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